The SPRINT trial randomized hypertensive patients (excluding diabetes mellitus) to a systolic blood pressure target below 120 mmHg versus below 140 mmHg. Which statement best describes the trade-off demonstrated?
- A Intensive control reduced cardiovascular events but significantly increased hypotension, syncope, electrolyte disorders and acute kidney injury ✓
- B Intensive control reduced cardiovascular events with no excess adverse events compared with standard control
- C Both groups had identical cardiovascular outcomes, but the intensive arm had fewer falls
- D Intensive control increased cardiovascular mortality, so the trial was stopped for harm
Correct answer: A. Intensive control reduced cardiovascular events but significantly increased hypotension, syncope, electrolyte disorders and acute kidney injury
Explanation
SPRINT showed that targeting systolic BP under 120 mmHg (measured by automated office BP) reduced the primary composite cardiovascular outcome by about 25% compared with a target under 140 mmHg. This benefit came at the cost of significantly higher rates of hypotension, syncope, electrolyte abnormalities and acute kidney injury or acute renal failure in the intensive arm. Patients with diabetes were excluded, so the result cannot be extrapolated blindly to them.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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